As you are aware, the Supreme Court reaffirmed last term that the
application of federal law regulating controlled substances is uniform throughout the
United States and may not be nullified by the legislative decisions of individual States. See
United States v. Oakland Cannabis Buyers' Coop., 532
U.S. 483 (2001). In light of this
decision, questions have been raised about the validity of an Attorney General letter
dated June 5, 1998, which overruled an earlier Drug Enforcement Administration (DEA)
determination that narcotics and other dangerous drugs controlled by federal law may not
be dispensed consistently with the Controlled Substances Act, 21
U.S.C. §§ 801-971 (1994
& Supp.II 1996) (CSA), to assist suicide in the United States. Upon review of the Oakland
Cannabis decision and other relevant authorities, I have concluded that the DEA's
original reading of the CSA  that controlled substances may not be dispensed to
assist suicide  was correct. I therefore advise you that the original DEA
determination is reinstated and should be implemented as set forth in greater detail
below.

1. Determination on Use of Federally Controlled Substances to
Assist Suicide. For the reasons set forth in the OLC Opinion, I hereby determine
that assisting suicide is not a "legitimate medical purpose" within the meaning
of 21
C.F.R. § 1306.04 (2001), and that prescribing, dispensing, or administering
federally controlled substances to assist suicide violates the CSA. Such conduct by a
physician registered to dispense controlled substances may "render his
registration inconsistent with the public interest" and therefore subject to
possible suspension or revocation under 21
U.S.C. § 824(a)(4). This conclusion applies
regardless of whether state law authorizes or permits such conduct by practitioners or
others and regardless of the condition of the person whose suicide is assisted.

I hereby direct the DEA, effective upon publication of this
memorandum in the Federal Register, to enforce and apply this determination,
notwithstanding anything to the contrary in the June 5, 1998, Attorney General's letter.

2. Use of Controlled Substances to Manage Pain Promoted.
Pain management, rather than assisted suicide, has long been recognized as a legitimate
medical purpose justifying physicians' dispensing of controlled substances. There are
important medical, ethical, and legal distinctions between intentionally causing a
patient's death and providing sufficient dosages of pain medication necessary to eliminate
or alleviate pain.

3. No Change in Current DEA Policies and Enforcement Practices
Outside Oregon. The reinstated determination makes no change in the current
standards and practices of the DEA in any State other than Oregon. Former Attorney General
Janet Reno's June 5, 1998, letter relating to this matter emphasized that action to revoke
the DEA registration of a physician who uses federally controlled substances to assist a
suicide "may well be warranted where a physician assists in a suicide in a state
that has not authorized the practice under any conditions." The reinstated
determination does not portend any increase in investigative activity or other change from
the manner in which the DEA presently enforces this policy outside of Oregon.

4. Enforcement in Oregon. Under 3
Oregon Revised Statutes (O.R.S.) § 127.855 (1999), an attending physician who writes a prescription for
medication to end the life of a qualified patient must document the medication prescribed.
Under 3 O.R.S. § 127.865(1)(b) (1999), the State of Oregon's Health Division must require
any health care provider upon dispensing medication pursuant to the Death with Dignity Act
to file a copy of the dispensing record with the Division. Those records should contain
the information necessary to determine whether those holding DEA registrations who assist
suicides in accordance with Oregon law are prescribing federally controlled substances for
that purpose in violation of the CSA as construed by this Memorandum and the attached OLC
Opinion.

The Department has the authority to take appropriate measures to
obtain copies of any such reports of records sent to the Oregon State Registrar. See21 U.S.C. § 876. When inspection of these documents discloses prohibited prescription of
controlled substances to assist suicide following the effective date of this memorandum,
then appropriate administrative action may be taken in accordance with 21
C.F.R. §§
1316.41 to 1316.68 (2001).

Thus, it should be possible to identify the cases in which federally
controlled substances are used to assist suicide in Oregon in compliance with Oregon law
by obtaining reports from the Oregon State Registrar without having to review patient
medical records or otherwise investigate doctors. Accordingly, implementation of this
directive in Oregon should not change the DEA's current practices with regard to enforcing
the CSA so as materially to increase monitoring or investigation of physicians or other
health care providers or to increase review of physicians' prescribing patterns of
controlled substances used for pain relief.

5. Distribution. Please ensure that this Memorandum and
the OLC opinion on which it is based are promptly distributed to appropriate DEA
personnel, especially those with authority over the enforcement of the CSA in Oregon.